Safety and effectiveness of large volume coils in the treatment of small aneurysms

2016 ◽  
Vol 8 (12) ◽  
pp. 1260-1263 ◽  
Author(s):  
Zsolt Kulcsár ◽  
Isabel Wanke ◽  
Daniel Rüfenacht ◽  
Stephan G Wetzel ◽  
Sophia Göricke ◽  
...  
Keyword(s):  
Large Volume ◽  
Packing Density ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Thromboembolic Complication ◽  
System A ◽  
Hemorrhagic Events ◽  
Progressive Occlusion ◽  
Small Aneurysms

Background and purposeLarge volume soft design coils facilitate quicker aneurysm filling and high packing density. Our purpose was to analyze the feasibility, safety, and effectiveness of the Penumbra Coil 400 (PC400) system in the treatment of small aneurysms.Materials and methodsA retrospective analysis of prospective data collected at three different centers was performed on consecutive aneurysms <10 mm treated with the PC400 system. A total of 92 aneurysms were included in the study. Feasibility, procedure safety, angiographic and clinical results, and follow-up results were evaluated.ResultsMean aneurysm size was 5.8±2.0 mm. An average of 2.5±1.3 coils with a mean length of 18±16 cm per aneurysm was used, resulting in a mean packing density of 45.6±14.4%. The thromboembolic event rate was 3.3% and no procedural aneurysm rupture was observed. Immediate adequate occlusion was achieved in 66% of aneurysms. During a mean follow-up period of 7.4 months the number of adequate occlusions increased to 91%.ConclusionsLarge volume PC 400 coils are safe and effective in the treatment of small aneurysms with a low thromboembolic complication rate and no hemorrhagic events. High packing densities are achieved with a low average number of coils used per aneurysm treated. The aneurysms demonstrated progressive occlusion over time, which probably suggests stability in the long term.

Early experience with the new endovascular aneurysm sealing system Nellix: First clinical results after 50 implantations

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 339-347 ◽  
Author(s):  
Sebastian Zerwes ◽  
Zmarai Nurzai ◽  
Giesbert Leissner ◽  
Thomas Kroencke ◽  
Hans-Kees Bruijnen ◽  
...  
Keyword(s):  
Clinical Results ◽  
Aneurysm Rupture ◽  
Type Ii ◽  
Technical Success ◽  
Secondary Intervention ◽  
System A ◽  
Contrast Enhanced ◽  
Single Center Study ◽  
Endoleak Type Ii

Objective In the present study, 50 EVAS procedures were evaluated in regard to primary (survival and technical success) and secondary (device-related complications) events of interest. Methods The single center study was conducted from July 2013 to August 2014 with prospective collection of the clinical data. The clinical results were controlled by CT angiography and contrast-enhanced ultrasound . Results The technical success was 98% and the 30-day mortality 4%. One (2%) patient died from multisystem organ failure and another patient from an intracranial bleeding, respectively. One patient (2%) suffered from a device-related aneurysm rupture. During early follow-up, one (2%) patient developed an endoleak type II, while three (6%) patients suffered from a partial endograft limb thrombosis. Overall, a secondary intervention was necessary in six (12%) patients. Conclusions With the Nellix EVAS system, a high primary technical success of 98% was achieved; one (2%) patient developed an endoleak type II which did not require secondary intervention. Those promising results are contrasted by a substantial rate of endograft limb thromboses (8%) and one (2%) intraoperative aneurysm rupture. Further studies are needed to assess the durability of the Nellix stentgraft and the occurrence of device-related complications.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

1997 ◽  
Vol 86 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Jean Raymond ◽  
Daniel Roy ◽  
Michel Bojanowski ◽  
Robert Moumdjian ◽  
Georges L'Espérance
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Clinically Significant ◽  
Technical Complication ◽  
Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

Abstract WMP30: Risk Analysis Of Growth And Rupture In Unruptured Intreacranial Aneurysms : Single Institutional Cohort Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yuichi Murayama ◽  
Toshihiro Ishibashi ◽  
Hiroyuki Takao ◽  
Ichiro Yuki ◽  
Hideki Arakawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Single Center ◽  
Risk Of Rupture ◽  
Aneurysm Growth ◽  
The Mean ◽  
Small Aneurysms

Introduction: Risk of growth and rupture in unruptured intracranial saccular aneurysm (UIA) are still unclear. Hypothesis: Gowth and risk of UIA may be correlated and they were evaluated our single center large cohort. Methods: Between January 2003 and March 2011, a total of 2122 patients with 2756 UIA were referred to our institution. 1403 patients with 2037 UIAs were assigned for conservative management. The mean follow up duration was 6201 aneurysm-years. Bi-annual three-dimensional computed tomography angiography (3D CTA) was performed and aneurysm growth was evaluated using 3D workstation. The aneurysm growth was defined as size increase more than 1mm. Results: During observation, 14.6% aneurysms increased their size. Female and male growth rate were 16% and 11% respectively. 130 patients stopped observation and therapeutic intervention was performed due to increase their size or anxiety. During observation 50 UIAs ruptured resulting in a 0.8% rupture rate per year. Aneurysm growth, IC-pcom aneurysms, posterior circulation, female, and SAH associated multiple aneurysms were risk factor for aneurysm rupture. Growing aneurysm was 10 times higher relative risk of rupture compare to stable aneurysm. No aneurysm demonstrated reduction of their size after rupture. Conclusions: Risk of Aneurysm growth and rupture may be correlated. Risk of rupture of UIAs was similar that was reported before but even small aneurysms can be rupture during observation. Growing UIAs should be considered to treat as soon as possible even in small size.

scholarly journals Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique

2014 ◽  
Vol 8 (1) ◽  
pp. 209-214
Author(s):  
Ioannis P Pengas ◽  
Angelos Assiotis ◽  
Michail Kokkinakis ◽  
Wasim S Khan ◽  
Paul Meyers ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Scoring Systems ◽  
Clinical Results ◽  
System A ◽  
Alternative Method ◽  
Surgical Fixation ◽  
Preoperative Status ◽  
Ikdc 2000 ◽  
Fixation System

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal.

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients

2020 ◽  
pp. 152660282097183
Author(s):  
Sebastian Zerwes ◽  
Johanna Kiessling ◽  
Dominik Liebetrau ◽  
Rudolf Jakob ◽  
Yvonne Gosslau ◽  
...  
Keyword(s):  
Blood Loss ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Technical Failure ◽  
Graft Thrombosis ◽  
Open Conversion ◽  
Technical Features

Purpose To evaluate the technical features and clinical results after open conversion for complications following endovascular aneurysm sealing (EVAS). Materials and Methods From July 2013 to February 2020, 44 patients (mean age 72±8 years; 36 men) underwent an open conversion due to EVAS complications in a single center. Data were collected on patient characteristics, reasons for conversion, characteristics and duration of the procedure, condition of the polymer, blood loss, time in the intensive care unit (ICU), and intra/postoperative complications. The main outcome measure was mortality at 30 days and in follow-up. Data are presented as the median (IQR) and absolute range. Results On average, the open conversion took place 3 years after the initial EVAS implantation [median 37 months (IQR 23, 50); range 0–64]. Most patients were converted due migration (82%), aneurysm growth (77%), and/or endoleak (75%), with 21 patients (48%) having all 3 events. Less frequent diagnoses were aneurysm rupture (n=7), aortic infection (n=3), technical failure during implantation (n=2), and graft thrombosis (n=1). The majority of patients (n=26) were asymptomatic and converted electively, but 9 were operated on urgently and 9 emergently (7 late rupture and 2 due to technical failure). The median procedure duration was 178 minutes (IQR 149, 223; range 87–417), the median blood loss was 1100 mL (IQR 600, 2600; range 300–5000). Polymer degradation was mentioned in the operative reports of 18 cases (41%). Patients stayed a median of 3 days (IQR 2, 7; range 1–35) in the ICU, while the median length of stay in the hospital was 14 days (IQR 10, 20; range 0–93). The 30-day mortality was 23% (n=10). During a median follow-up of 3 months (IQR 0, 11; range 0–38), no additional deaths occurred, but 12 patients suffered from an adverse event. There were 3 cases of wound dehiscence after laparotomy, 2 cases of leg ischemia, 2 cases of renal failure, and individual cases of urinary obstruction, urinoma, paralytic ileus, gastrointestinal bleeding, and postoperative delirium. A non-elective setting was associated with a significantly increased mortality of 33% in urgent cases and 56% in emergent cases (p=0.007). Based on these results an algorithm for the management of EVAS complications was developed. Conclusion The significantly increased mortality associated with nonelective conversions highlights the need for active surveillance. The presented algorithm offers a structured tool to avoid emergency conversions.

scholarly journals Endovascular Treatment of Very Small Intracranial Aneurysms

2011 ◽  
Vol 17 (3) ◽  
pp. 299-305 ◽  
Author(s):  
A. Iskandar ◽  
J. Nepper-Rasmussen
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Clinical Results ◽  
Maximal Diameter ◽  
Increased Risk ◽  
Retreatment Rate ◽  
Aneurysm Occlusion ◽  
Small Aneurysms

The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm). Between November 1999 and November 2009 endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms and subsequently comparing it to the results of larger aneurysms. Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54 aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated with a higher rate of procedural ruptures (7.2% versus 4.4%) and procedural mortality (4.7% versus 2.7%) but a lower procedural morbidity (1.9% versus 4.0%). However none of these differences reached statistical significance (p = 0.186, p= 0.388, respectively). The retreatment rate was higher for the larger aneurysms (8.2% and 6.3%), but this was not significant either (p= 0. 496). At nine-month follow-up significantly more small aneurysms were found to have a stable occlusion grade compared to large aneurysms. Endovascular treatment of very small aneurysms is feasible with a lower retreatment rate compared to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms.

scholarly journals Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results

2017 ◽  
Vol 10 (7) ◽  
pp. 629-633 ◽  
Author(s):  
Matthias Gawlitza ◽  
Sebastien Soize ◽  
Anne-Christine Januel ◽  
Cristian Mihalea ◽  
Georgios-Emmanouil Metaxas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Thromboembolic Complication ◽  
Safety And Efficacy ◽  
Complete Occlusion ◽  
Permanent Morbidity ◽  
Woven Endobridge ◽  
Web Device ◽  
The Web

BackgroundThe safety and efficacy of the Woven EndoBridge (WEB) for the treatment of naïve intracranial aneurysms has been confirmed.PurposeTo analyze the safety and efficacy of the WEB in the treatment of recurrent aneurysms.MethodsAnatomical and clinical results in consecutive patients with a recurrent aneurysm, who were treated using the WEB device in two French neurointerventional centers, were evaluated.ResultsSeventeen patients with 17 aneurysms were included. Treatment was feasible in 16 patients. In seven patients (41.2%), ancillary devices were used. Permanent morbidity due to a thromboembolic complication occurred in one patient (5.9%). There was no mortality. Follow-up angiographic studies were available for 15 patients after a mean of 12.1±6.1 months. Rates of complete occlusion, neck remnant, and aneurysm remnant were 33.3%, 40.0%, and 26.7%, respectively.ConclusionsTreatment of recurrent aneurysms using the WEB device may be reasonably safe and effective.

scholarly journals Clinical results of whiteside ortholoc total knee system - A short-term follow-up study.

1988 ◽  
Vol 36 (3) ◽  
pp. 910-913
Author(s):  
Masaaki Fujita ◽  
Toshiharu Norimatsu ◽  
Nobuou Matsusaka ◽  
Tsukasa Teramoto ◽  
Ryohei Suzuki
Keyword(s):  
Clinical Results ◽  
Short Term ◽  
Follow Up Study ◽  
System A ◽  
Total Knee

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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